EP3331448B1 - Method for creating a 3d dental x-ray image - Google Patents

Method for creating a 3d dental x-ray image Download PDF

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Publication number
EP3331448B1
EP3331448B1 EP16759986.9A EP16759986A EP3331448B1 EP 3331448 B1 EP3331448 B1 EP 3331448B1 EP 16759986 A EP16759986 A EP 16759986A EP 3331448 B1 EP3331448 B1 EP 3331448B1
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Prior art keywords
patient
core volume
volume
angle
ray
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German (de)
French (fr)
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EP3331448A1 (en
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Christian Beckhaus
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Sirona Dental Systems GmbH
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Sirona Dental Systems GmbH
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    • A61B6/51—
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/02—Devices for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computerised tomographs
    • A61B6/032—Transmission computed tomography [CT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/08—Auxiliary means for directing the radiation beam to a particular spot, e.g. using light beams
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems

Definitions

  • the invention relates to a method for producing a dental 3D X-ray image of a jaw region of a patient from a plurality of projection images of a recording volume having a cylindrical core volume with a base area generated during a rotation of an X-ray emitter and an X-ray detector around a head of the patient. that the jaw area is within the core volume.
  • the patient In known dental X-ray machines for taking photographs in the jaw or head region of a patient, the patient is positioned lying, standing or sitting. For positioning, e.g. a bite or a forehead rest.
  • a method and a device for generating a 3D X-ray image is known, wherein a patient is positioned by means of a bite between an X-ray emitter and an X-ray detector and the X-ray image is generated by a circulation of X-ray emitter and X-ray detector around the positioned patient.
  • a positioning device for measuring a lower jaw wherein the lower edge of the lower jaw of a patient is aligned parallel to the horizontal.
  • the device makes it possible to achieve a precisely reproducible positioning.
  • the receiving volume of such a device is approximately cylindrical with a horizontally extending base.
  • the size in particular the height, depends essentially on the size or height of the detector and the X-ray beam and must be matched to the size of the object to be recorded, ie the size of a human jaw.
  • the object now is to further develop the methods known from the prior art and, in particular, to enable the best possible utilization of the receiving volume or a reduction of the necessary receiving volume when displaying the complete jaw area, including the temporomandibular joints.
  • An object of the invention is a method for producing a dental 3D X-ray image of a patient's jaw region from a plurality of projection recordings of a recording volume having a cylindrical core volume with a planar base area produced during a rotation of an X-ray emitter and an X-ray detector around a head of the patient positioning the jaw area within the core volume and aligning a lower edge of a patient's mandible and the base area of the core volume at least approximately parallel to one another.
  • a typical X-ray machine for generating a dental 3D image has a recorded by the circulation of X-ray detector and X-ray source recording volume.
  • the shape of the receiving volume is determined by the orbit of the detector and radiator and by the example funnel-shaped shape and the orientation of the X-ray beam. This can, for example, lead to a so-called 100% intake volume with an increasing height in the direction of a center, for example a cylindrical volume with cones attached on one or both sides.
  • the receiving volume may also have any other form of receiving volume, for example spherical, ellipsoidal, conical etc.
  • the jaw area In order to measure the jaw area of a patient, the jaw area must be positioned within the receiving volume. In order to keep the radiation exposure as low as possible, the size of the receiving volume should not exceed the size of the jaw area, even if the shape of the receiving volume of course does not necessarily correspond to the shape of the volume occupied by the jaw area.
  • Core volume is a partial volume of this recording volume referred to, on the one hand still completely within the receiving volume, so can be used for surveying and should, and on the other hand is cylindrical, wherein the base of the core volume at least approximately perpendicular to the or axes of rotation of the X-ray detector or aligned with the X-ray source and serves as a reference for the orientation of the patient.
  • the core volume has the shape of a general cylinder, which has a flat base surface, a cover surface corresponding to the base area, displaced along a straight line relative to the base surface and a lateral surface which just connects these two surfaces.
  • the core volume must be so large that it covers the entire area to be absorbed, for example, the entire jaw area.
  • the receiving volume is ideally not much larger than the core volume and the core volume in the ideal case, at least theoretically corresponds exactly to the reliably usable for the measurement part of the receiving volume of the X-ray device.
  • X-ray devices whose radiator and detector rotate about a vertical axis, have a core volume with an at least approximately horizontal base surface on. The patient is positioned sitting or standing between X-ray source and X-ray detector.
  • X-ray devices allow a horizontal positioning of the patient, wherein emitter and detector respectively revolve about an at least approximately horizontal axis and the base surface of the cylindrical core volume is at least approximately vertical.
  • the lower edge of the lower jaw slopes slightly obliquely from the chin to the back of the head, while the occlusal plane is substantially horizontal. If the head is overstretched, ie tilted backwards, the lower edge of the lower jaw can be aligned parallel to a horizontal plane, while the occlusal plane is inclined.
  • An alignment of the lower edge of the lower jaw parallel to the base area of the core volume which is achieved by an overstretching of the head, allows optimal utilization of the core volume, since the jaw area in an overstretched head occupies a volume that comes particularly close to a cylindrical volume with a horizontal base.
  • An advantage of this positioning is that the height of the core volume can be kept low and still the entire jaw area with the temporomandibular joint and possibly also the maxillary sinus can be accommodated. Furthermore, the jaw region is positioned by such an orientation in the core volume that the inclusion of further, possibly disturbing structures, such as the cervical spine is largely avoided. Furthermore, it is achieved by this positioning that the particularly radiation-sensitive organs eyes and thyroid largely irradiated outside of the Volume, whereby the effective dose of a recording is significantly reduced.
  • a first angle of an occlusal plane and / or a temporomandibular joint of the positioned patient relative to the base area or a lateral surface of the core volume is determined, and a position correction of the 3D x-ray exposure by the first angle is performed.
  • the occlusal plane that is, the bite surface in normal head posture of a standing or sitting patient is substantially horizontal
  • the first angle between the occlusal plane of a positioned patient to a horizontally extending base of a standing or sitting positioning X-ray device gives the deviation of the position of the patient the normal head posture. The same applies to a horizontal positioning and a vertical base of the core volume.
  • the 3D X-ray image can be displayed in a normal head posture.
  • a familiar view of the jaw in the obtained 3D X-ray image can be provided.
  • This position correction can be performed directly during or during the reconstruction or only subsequently for the display of the reconstructed data in a display program.
  • a first angle of an occlusal plane or a temporomandibular joint of the positioned patient relative to the base surface or a lateral surface of the core volume is determined and a position correction of the 3D X-ray image is made by a second angle having a fixed difference to the first angle.
  • a mechanical positioning means in particular a bite and / or a forehead support and / or a chin support and / or a support for the root of the nose is used for positioning.
  • a bite for example, is a mechanical positioning means which has a region to be taken from a patient into the mouth. This can be, for example, an occlusal bite. The bite allows both easy positioning and easy determination of the angle of deviation from normal head posture.
  • a light or laser range display is used for positioning. Also, by means of a light or laser range display, so on the patient's head projected laser lines, the positioning of the patient can be made easy and comfortable for the patient or controlled.
  • the determination of the angle of deviation from normal head posture may e.g. via a statistical average obtained from many acquisition data or a determination of the occlusal plane in the reconstructed data set by means of suitable algorithms, such as e.g. Segmentation of occlusal surfaces, done.
  • the light or laser range display is a light or laser sight.
  • the Fig. 1A schematically shows a patient's head 1 in a natural head posture, in which a lower jaw 2 and a jaw joint 3 are outlined.
  • a cylindrical core volume 4 of a receiving volume (not shown) with a height 5 and a base 11 is shown by lateral boundary lines and covers the lower jaw 2 at least partially.
  • An occlusal plane 8 of the lower jaw 2 runs approximately parallel to the base surface 11 of the core volume 4.
  • the core volume 4 would have to be increased in this illustrated head posture or alignment of the head.
  • other structures are included, which can disturb the recording quality of the 3D X-ray or are particularly sensitive to X-rays.
  • a part of the cervical spine 6 is included in a natural head posture and a too large depth of the core volume 4.
  • Fig. 1B the head 1 of the patient has been brought from the natural head posture into an overstretched posture.
  • a bite 7 be used, which aligns the occlusal plane 8 at a first angle 9 to the base 11.
  • the first angle 9 is adjusted so that a lower edge 10 of the lower jaw 2 is aligned as parallel as possible to the base surface 11 of the cylindrical core volume 4.
  • a height of the bite 7 is adjusted so that the lower edge 10 is positioned at the level of the base 11 or slightly above.
  • the core volume 4 is sufficient to detect the entire maxillary mandibular area (not shown), lower jaw 2 and temporomandibular joint 3.
  • An increase in height 5 is not necessary.
  • the radiation exposure for the patient can be kept low.
  • the positioning according to the invention makes it possible to pick up disturbing structures, such as e.g. the cervical spine are avoided.
  • Lower requirements for the maximum height 5 of the core volume 4 and corresponding to the total receiving volume also allow the use of a more cost-effective recording device or lower production costs of X-ray source and detector (not shown).
  • FIGS. 2A and 2B the positioning of the patient's head 1 is sketched by means of a laser range indicator 12.
  • a laser range indicator 12 For positioning, two lines are projected on the patient's head 1 by means of a laser or another light source (not shown), for example by means of a light or laser sight, as a laser range display 12, which shows the height 5, the course of the base 11 and the spatial position of the patient Core volume 4 (outlined by dotted lines).
  • the patient's head 1 is aligned so that the lower edge 10 of the lower jaw 2 approximately parallel to the lower line of the laser range indicator 12 extends.
  • a further line running centrally between the two lines can be projected, which, with an optimal coordination of position and size of the lower jaw and core volume to be picked up, should extend from a cleft lip of the patient to an auditory canal of the patient.

Description

Technisches GebietTechnical area

Die Erfindung betrifft ein Verfahren zur Erstellung einer dentalen 3D-Röntgenaufnahme eines Kieferbereichs eines Patienten aus mehreren während eines Umlaufs eines Röntgenstrahlers und eines Röntgendetektors um einen Kopf des Patienten erzeugten Projektionsaufnahmen eines Aufnahmevolumens mit einem zylinderförmigen Kernvolumen mit einer Grundfläche, wobei der Patient so positioniert wird, dass sich der Kieferbereich innerhalb des Kernvolumens befindet.The invention relates to a method for producing a dental 3D X-ray image of a jaw region of a patient from a plurality of projection images of a recording volume having a cylindrical core volume with a base area generated during a rotation of an X-ray emitter and an X-ray detector around a head of the patient. that the jaw area is within the core volume.

Stand der TechnikState of the art

In bekannten dentalen Röntgengeräten zur Erstellung von Aufnahmen im Kiefer- oder Kopfbereich eines Patienten wird der Patient liegend, stehend oder sitzend positioniert. Zur Positionierung dient z.B. ein Aufbiss oder eine Stirnstütze.In known dental X-ray machines for taking photographs in the jaw or head region of a patient, the patient is positioned lying, standing or sitting. For positioning, e.g. a bite or a forehead rest.

Aus der DE 10 2008 035 412 A1 ist beispielsweise ein Verfahren und eine Vorrichtung zur Erzeugung einer 3D-Röntgenaufnahme bekannt, wobei ein Patient mittels eines Aufbisses zwischen einem Röntgenstrahler und einem Röntgendetektor positioniert wird und die Röntgenaufnahme durch einen Umlauf von Röntgenstrahler und Röntgendetektor um den positionierten Patienten erzeugt wird.From the DE 10 2008 035 412 A1 For example, a method and a device for generating a 3D X-ray image is known, wherein a patient is positioned by means of a bite between an X-ray emitter and an X-ray detector and the X-ray image is generated by a circulation of X-ray emitter and X-ray detector around the positioned patient.

Aus der US 2003/0058988 A1 ist eine Positioniervorrichtung für das Vermessen eines Unterkiefers bekannt, wobei die Unterkante des Unterkiefers eines Patienten parallel zur Horizontalen ausgerichtet wird. Die Vorrichtung ermöglicht es, eine genau reproduzierbare Positionierung zu erreichen.From the US 2003/0058988 A1 a positioning device for measuring a lower jaw is known, wherein the lower edge of the lower jaw of a patient is aligned parallel to the horizontal. The device makes it possible to achieve a precisely reproducible positioning.

Aus der DE 199 62 205 A1 ist bekannt, bei der Bestimmung von Zahnachsenneigungen aus Röntgenaufnahmen eine Schieflage des Patientenkopfen relativ zu der Aufnahmevorrichtung zu berücksichtigen und zu korrigieren.From the DE 199 62 205 A1 It is known to take into account and correct an imbalance of the patient's head relative to the receiving device when determining tooth axis inclinations from X-ray images.

Das Aufnahmevolumen einer solchen Vorrichtung ist näherungsweise zylinderförmig mit horizontal verlaufender Grundfläche. Die Größe, insbesondere die Höhe, richtet sich im Wesentlichen nach der Größe bzw. Höhe des Detektors und des Röntgenstrahls und muss auf die Größe des Aufzunehmenden Objekts, also die Größe eines menschlichen Kiefers abgestimmt sein.The receiving volume of such a device is approximately cylindrical with a horizontally extending base. The size, in particular the height, depends essentially on the size or height of the detector and the X-ray beam and must be matched to the size of the object to be recorded, ie the size of a human jaw.

Die Aufgabe besteht nun darin, die aus dem Stand der Technik bekannten Verfahren weiterzubilden und insbesondere eine möglichst optimale Ausnutzung des Aufnahmevolumens bzw. eine Reduktion des notwendigen Aufnahmevolumens bei Darstellung des kompletten Kieferbereichs inklusive der Kiefergelenke zu ermöglichen.The object now is to further develop the methods known from the prior art and, in particular, to enable the best possible utilization of the receiving volume or a reduction of the necessary receiving volume when displaying the complete jaw area, including the temporomandibular joints.

Darstellung der ErfindungPresentation of the invention

Ein Gegenstand der Erfindung ist ein Verfahren zur Erstellung einer dentalen 3D-Röntgenaufnahme eines Kieferbereichs eines Patienten aus mehreren während eines Umlaufs eines Röntgenstrahlers und eines Röntgendetektors um einen Kopf des Patienten erzeugten Projektionsaufnahmen eines Aufnahmevolumens mit einem zylinderförmigen Kernvolumen mit einer ebenen Grundfläche, wobei der Patient so positioniert wird, dass sich der Kieferbereich innerhalb des Kernvolumens befindet und eine Unterkante eines Unterkiefers des Patienten und die Grundfläche des Kernvolumens zumindest näherungsweise parallel zueinander ausgerichtet werden.An object of the invention is a method for producing a dental 3D X-ray image of a patient's jaw region from a plurality of projection recordings of a recording volume having a cylindrical core volume with a planar base area produced during a rotation of an X-ray emitter and an X-ray detector around a head of the patient positioning the jaw area within the core volume and aligning a lower edge of a patient's mandible and the base area of the core volume at least approximately parallel to one another.

Ein typisches Röntgengerät zur Erzeugung einer dentalen 3D-Aufnahme weist ein durch den Umlauf von Röntgendetektor und Röntgenstrahler abgetastetes Aufnahmevolumen auf. Die Form des Aufnahmevolumens wird durch die Umlaufbahn von Detektor und Strahler sowie durch die beispielsweise trichterförmige Form und die Ausrichtung des Röntgenstrahls bedingt. Dies kann beispielsweise zu einem so genannten 100%-Aufnahmevolumen mit einer in Richtung eines Zentrums zunehmenden Höhe führen, z.B. einem zylinderförmigen Volumen mit einseitig oder beidseitig aufgesetzten Kegeln. Das Aufnahmevolumen kann in Abhängigkeit von dem Verwendeten Röntgengerät aber auch jede andere Form des Aufnahmevolumens aufweisen, z.B. kugelförmig, ellipsoid, kegelförmig etc.A typical X-ray machine for generating a dental 3D image has a recorded by the circulation of X-ray detector and X-ray source recording volume. The shape of the receiving volume is determined by the orbit of the detector and radiator and by the example funnel-shaped shape and the orientation of the X-ray beam. This can, for example, lead to a so-called 100% intake volume with an increasing height in the direction of a center, for example a cylindrical volume with cones attached on one or both sides. Depending on the X-ray apparatus used, however, the receiving volume may also have any other form of receiving volume, for example spherical, ellipsoidal, conical etc.

Um den Kieferbereich eines Patienten zu vermessen, muss der Kieferbereich innerhalb des Aufnahmevolumens positioniert werden. Um die Strahlenbelastung möglichst gering zu halten, sollte hierbei die Größe des Aufnahmevolumens die Größe des Kieferbereichs nicht besonders übersteigen, auch wenn die Form des Aufnahmevolumens natürlich nicht unbedingt der Form des Volumens entspricht, welches der Kieferbereich einnimmt.In order to measure the jaw area of a patient, the jaw area must be positioned within the receiving volume. In order to keep the radiation exposure as low as possible, the size of the receiving volume should not exceed the size of the jaw area, even if the shape of the receiving volume of course does not necessarily correspond to the shape of the volume occupied by the jaw area.

Mit Kernvolumen wird ein Teilvolumen dieses Aufnahmevolumens bezeichnet, welches einerseits noch vollständig innerhalb des Aufnahmevolumens liegt, also zur Vermessung verwendet werden kann und soll, und andererseits zylinderförmig ausgebildet ist, wobei die Grundfläche des Kernvolumens zumindest näherungsweise senkrecht zu der oder den Rotationsachsen des Röntgendetektors bzw. des Röntgenstrahlers ausgerichtet ist und als Referenz für die Ausrichtung des Patienten dient. Es sei angemerkt, dass das Kernvolumen die Form eines allgemeinen Zylinders hat, der eine ebene Grundfläche, eine der Grundfläche entsprechende, entlang einer Geraden relativ zur Grundfläche verschobene Deckfläche und eine diese beiden Flächen gerade verbindende Mantelfläche aufweist. Das Kernvolumen muss so groß sein, dass es den gesamten aufzunehmenden Bereich, also beispielsweise den gesamten Kieferbereich abdeckt. Es versteht sich, dass das Aufnahmevolumen idealerweise nicht viel größer als das Kernvolumen ist und das Kernvolumen im Idealfall zumindest theoretisch genau dem für die Vermessung zuverlässig verwendbaren Teil des Aufnahmevolumens des Röntgengeräts entspricht.Core volume is a partial volume of this recording volume referred to, on the one hand still completely within the receiving volume, so can be used for surveying and should, and on the other hand is cylindrical, wherein the base of the core volume at least approximately perpendicular to the or axes of rotation of the X-ray detector or aligned with the X-ray source and serves as a reference for the orientation of the patient. It should be noted that the core volume has the shape of a general cylinder, which has a flat base surface, a cover surface corresponding to the base area, displaced along a straight line relative to the base surface and a lateral surface which just connects these two surfaces. The core volume must be so large that it covers the entire area to be absorbed, for example, the entire jaw area. It is understood that the receiving volume is ideally not much larger than the core volume and the core volume in the ideal case, at least theoretically corresponds exactly to the reliably usable for the measurement part of the receiving volume of the X-ray device.

Röntgengeräte, deren Strahler und Detektor sich um eine vertikale Achse drehen, weisen ein Kernvolumen mit einer zumindest näherungsweise horizontal verlaufenden Grundfläche auf. Der Patient wird sitzend oder stehend zwischen Röntgenstrahler und Röntgendetektor positioniert.X-ray devices, whose radiator and detector rotate about a vertical axis, have a core volume with an at least approximately horizontal base surface on. The patient is positioned sitting or standing between X-ray source and X-ray detector.

Andere Röntgengeräte ermöglichen eine liegende Positionierung des Patienten, wobei Strahler und Detektor entsprechend um eine zumindest näherungsweise horizontale Achse kreisen und die Grundfläche das zylinderförmige Kernvolumen zumindest näherungsweise vertikal verläuft.Other X-ray devices allow a horizontal positioning of the patient, wherein emitter and detector respectively revolve about an at least approximately horizontal axis and the base surface of the cylindrical core volume is at least approximately vertical.

Bei einer normalen geraden Kopfhaltung eines stehenden oder sitzenden Patienten verläuft die Unterkante des Unterkiefers leicht schräg vom Kinn zum Hinterkopf hin ansteigend, während die Okklusionsebene im Wesentlichen horizontal verläuft. Wird der Kopf überstreckt, also nach hinten geneigt, so kann die Unterkante des Unterkiefers parallel zu einer horizontalen Ebene ausgerichtet werden, während die Okklusionsebene schräg verläuft.In a normal straight head posture of a standing or sitting patient, the lower edge of the lower jaw slopes slightly obliquely from the chin to the back of the head, while the occlusal plane is substantially horizontal. If the head is overstretched, ie tilted backwards, the lower edge of the lower jaw can be aligned parallel to a horizontal plane, while the occlusal plane is inclined.

Eine Ausrichtung der Unterkante des Unterkiefers parallel zur Grundfläche des Kernvolumens, die durch ein Überstrecken des Kopfes erreicht wird, ermöglicht eine optimale Ausnutzung des Kernvolumens, da der Kieferbereich in einer überstreckten Kopfhalten ein Volumen einnimmt, welches einem zylinderförmigen Volumen mit horizontaler Grundfläche besonders nahe kommt.An alignment of the lower edge of the lower jaw parallel to the base area of the core volume, which is achieved by an overstretching of the head, allows optimal utilization of the core volume, since the jaw area in an overstretched head occupies a volume that comes particularly close to a cylindrical volume with a horizontal base.

Ein Vorteil dieser Positionierung ist, dass die Höhe des Kernvolumens gering gehalten und trotzdem der gesamte Kieferbereich mit dem Kiefergelenk und gegebenenfalls auch der Kieferhöhle aufgenommen werden kann. Ferner ist der Kieferbereich durch eine solche Ausrichtung so im Kernvolumen positioniert, dass das Aufnehmen weiterer, eventuell störender Strukturen, wie der Halswirbelsäule weitgehend vermieden wird. Weiterhin wird durch diese Positionierung erreicht, dass die besonders strahlungsempfindlichen Organe Augen und Schilddrüse weitestgehend außerhalb des bestrahlten Volumens liegen, wodurch die Effektivdosis einer Aufnahme deutlich reduziert wird.An advantage of this positioning is that the height of the core volume can be kept low and still the entire jaw area with the temporomandibular joint and possibly also the maxillary sinus can be accommodated. Furthermore, the jaw region is positioned by such an orientation in the core volume that the inclusion of further, possibly disturbing structures, such as the cervical spine is largely avoided. Furthermore, it is achieved by this positioning that the particularly radiation-sensitive organs eyes and thyroid largely irradiated outside of the Volume, whereby the effective dose of a recording is significantly reduced.

Erfindungsgemäß wird ein erster Winkel einer Okklusionsebene und/oder eines Kiefergelenks des positionierten Patienten relativ zu der Grundfläche oder einer Mantelfläche des Kernvolumens bestimmt und eine Lagekorrektur der 3D-Röntgenaufnahme um den ersten Winkel vorgenommen. Da die Okklusionsebene, also die Bissfläche bei normaler Kopfhaltung eines stehenden oder sitzenden Patienten im Wesentlichen horizontal verläuft, gibt der erste Winkel zwischen der Okklusionsebene eines positionierten Patienten zu einer horizontal verlaufenden Grundfläche eines für stehende oder sitzende Positionierung konzipierten Röntgengeräts die Abweichung der Position des Patienten von der normalen Kopfhaltung an. Entsprechendes gilt für eine liegende Positionierung und eine vertikal verlaufende Grundfläche des Kernvolumens. Durch das Vornehmen einer Lagekorrektur um den ersten Winkel kann die 3D-Röntgenaufnahme in einer normalen Kopfhaltung dargestellt werden. So kann trotz einer überstreckten Positionierung des Kopfes während der Aufnahme eine gewohnte Ansicht des Kiefers in der erhaltenen 3D-Röntgenaufnahme bereitgestellt werden. Diese Lagekorrektur kann direkt bei bzw. während der Rekonstruktion oder auch erst anschließend für die Darstellung der rekonstruierten Daten in einem Anzeigeprogramm vorgenommen werden. Vorteilhafterweise wird ein erster Winkel einer Okklusionsebene oder eines Kiefergelenk des positionierten Patienten relativ zu der Grundfläche oder einer Mantelfläche des Kernvolumens bestimmt und eine Lagekorrektur der 3D-Röntgenaufnahme um einen zweiten Winkel vorgenommen wird, der eine feste Differenz zu dem ersten Winkel aufweist. Besteht besonderes Interesse an einem Teilbereich des zu vermessenden Kieferbereichs, z.B. das Gaumendach oder der Sinusboden, so kann dies durch einen Offset bei der Lagekorrektur berücksichtigt werden, so dass die dargestellten Daten einer Aufnahme eines leicht nach vorn oder nach hinten geneigten Kopfes entsprechen.According to the invention, a first angle of an occlusal plane and / or a temporomandibular joint of the positioned patient relative to the base area or a lateral surface of the core volume is determined, and a position correction of the 3D x-ray exposure by the first angle is performed. Since the occlusal plane, that is, the bite surface in normal head posture of a standing or sitting patient is substantially horizontal, the first angle between the occlusal plane of a positioned patient to a horizontally extending base of a standing or sitting positioning X-ray device gives the deviation of the position of the patient the normal head posture. The same applies to a horizontal positioning and a vertical base of the core volume. By making a position correction about the first angle, the 3D X-ray image can be displayed in a normal head posture. Thus, despite an over-extended positioning of the head during the recording, a familiar view of the jaw in the obtained 3D X-ray image can be provided. This position correction can be performed directly during or during the reconstruction or only subsequently for the display of the reconstructed data in a display program. Advantageously, a first angle of an occlusal plane or a temporomandibular joint of the positioned patient relative to the base surface or a lateral surface of the core volume is determined and a position correction of the 3D X-ray image is made by a second angle having a fixed difference to the first angle. There is special interest in a sub-area of the to be measured Jaw area, for example, the roof of the roof or the sinus floor, this can be taken into account by an offset in the position correction, so that the data shown correspond to a recording of a slightly tilted forward or backward head.

Vorteilhafterweise wird zur Positionierung ein mechanisches Positioniermittel, insbesondere ein Aufbiss und/oder eine Stirnstütze und/oder eine Kinnauflage und/oder eine Auflage für die Nasenwurzel verwendet. Als Positioniermittel kann jedes bekannte Positioniermittel eingesetzt werden. Ein Aufbiss ist beispielsweise ein mechanisches Positioniermittel, welche einen von einem Patienten in den Mund zu nehmenden Bereich aufweist. Dies kann beispielsweise ein Okklusalaufbiss sein. Der Aufbiss ermöglicht sowohl ein einfaches Positionieren als auch ein einfaches Bestimmen des Winkels der Abweichung von einer normalen Kopfhaltung.Advantageously, a mechanical positioning means, in particular a bite and / or a forehead support and / or a chin support and / or a support for the root of the nose is used for positioning. As positioning any known positioning can be used. A bite, for example, is a mechanical positioning means which has a region to be taken from a patient into the mouth. This can be, for example, an occlusal bite. The bite allows both easy positioning and easy determination of the angle of deviation from normal head posture.

Vorteilhafterweise wird zur Positionierung eine Licht- oder Laserbereichsanzeige verwendet. Auch mittels einer Licht- oder Laserbereichsanzeige, also auf den Patientenkopf projizierten Laserlinien, kann das Positionieren des Patienten einfach und für den Patienten angenehm vorgenommen bzw. kontrolliert werden.Advantageously, a light or laser range display is used for positioning. Also, by means of a light or laser range display, so on the patient's head projected laser lines, the positioning of the patient can be made easy and comfortable for the patient or controlled.

Die Bestimmung des Winkels der Abweichung von einer normalen Kopfhaltung kann z.B. über einen aus vielen Aufnahmedaten gewonnenen statistischen Mittelwert oder eine Bestimmung der Okklusalebene im rekonstruierten Datensatz mit Hilfe geeigneter Algorithmen, wie z.B. Segmentierung der Kauflächen, erfolgen.The determination of the angle of deviation from normal head posture may e.g. via a statistical average obtained from many acquisition data or a determination of the occlusal plane in the reconstructed data set by means of suitable algorithms, such as e.g. Segmentation of occlusal surfaces, done.

Vorteilhafterweise ist die Licht- oder Laserbereichsanzeige ein Licht- oder Laservisier.Advantageously, the light or laser range display is a light or laser sight.

Kurzbeschreibung der ZeichnungenBrief description of the drawings

Ausführungsbeispiele der Erfindung sind in der Zeichnung dargestellt. Es zeigt die

Fig. 1A,B
das Positionieren eines Patienten mittels eines Aufbisses und die
Fig. 2A,B
das Positionieren eines Patienten mittels einer Laserbereichsanzeige.
Embodiments of the invention are illustrated in the drawing. It shows the
Fig. 1A, B
the positioning of a patient by means of a bite and the
Fig. 2A, B
positioning a patient using a laser range indicator.

Ausführungsbeispieleembodiments

Die Fig. 1A zeigt schematisch einen Patientenkopf 1 in einer natürlichen Kopfhaltung, in dem ein Unterkiefer 2 und ein Kiefergelenk 3 skizziert sind. Ein zylinderförmiges Kernvolumen 4 eines Aufnahmevolumens (nicht dargestellt) mit einer Höhe 5 und einer Grundfläche 11 ist durch seitliche Begrenzungslinien dargestellt und deckt den Unterkiefer 2 zumindest teilweise ab. Eine Okklusionsebene 8 des Unterkiefers 2 verläuft näherungsweise parallel zur Grundfläche 11 des Kernvolumens 4.The Fig. 1A schematically shows a patient's head 1 in a natural head posture, in which a lower jaw 2 and a jaw joint 3 are outlined. A cylindrical core volume 4 of a receiving volume (not shown) with a height 5 and a base 11 is shown by lateral boundary lines and covers the lower jaw 2 at least partially. An occlusal plane 8 of the lower jaw 2 runs approximately parallel to the base surface 11 of the core volume 4.

Um den gesamten Unterkiefer 2, insbesondere auch das Kiefergelenk 3 und bevorzugt auch einen Oberkiefer (nicht dargestellt) aufzunehmen, müsste das Kernvolumen 4 bei dieser dargestellten Kopfhaltung bzw. Ausrichtung des Kopfes vergrößert werden. Je nach Größe bzw. Tiefe des Kernvolumens 4 werden allerdings auch andere Strukturen mit aufgenommen, welche die Aufnahmequalität der 3D-Röntgenaufnahme stören können oder besonders empfindlich gegenüber Röntgenstrahlung sind. Wie in Fig. 1A skizziert, wird bei einer natürlichen Kopfhaltung und einer zu großen Tiefe des Kernvolumens 4 ein Teil der Halswirbelsäule 6 mit aufgenommen.In order to accommodate the entire lower jaw 2, in particular also the temporomandibular joint 3 and preferably also an upper jaw (not shown), the core volume 4 would have to be increased in this illustrated head posture or alignment of the head. Depending on the size or depth of the core volume 4, however, other structures are included, which can disturb the recording quality of the 3D X-ray or are particularly sensitive to X-rays. As in Fig. 1A sketched, a part of the cervical spine 6 is included in a natural head posture and a too large depth of the core volume 4.

In Fig. 1B ist der Kopf 1 des Patienten aus der natürlichen Kopfhaltung in eine überstreckte Haltung gebracht worden. Hierfür kann, wie in Fig. 1B dargestellt, ein Aufbiss 7 verwendet werden, der die Okklusionsebene 8 in einem ersten Winkel 9 zur Grundfläche 11 ausrichtet. Der erste Winkel 9 wird so eingestellt, dass eine Unterkante 10 des Unterkiefers 2 möglichst parallel zur Grundfläche 11 des zylinderförmigen Kernvolumens 4 ausgerichtet ist. Eine Höhe des Aufbisses 7 wird so eingestellt, dass die Unterkante 10 auf Höhe der Grundfläche 11 oder etwas darüber positioniert ist.In Fig. 1B the head 1 of the patient has been brought from the natural head posture into an overstretched posture. For this, as in Fig. 1B represented, a bite 7 be used, which aligns the occlusal plane 8 at a first angle 9 to the base 11. The first angle 9 is adjusted so that a lower edge 10 of the lower jaw 2 is aligned as parallel as possible to the base surface 11 of the cylindrical core volume 4. A height of the bite 7 is adjusted so that the lower edge 10 is positioned at the level of the base 11 or slightly above.

In dieser überstreckten Positionierung des Kopfes 1 reicht das Kernvolumen 4 aus, um den gesamten Kieferbereichs aus Oberkiefer (nicht dargestellt) Unterkiefer 2 und Kiefergelenk 3 zu erfassen. Eine Vergrößerung hinsichtlich der Höhe 5 ist nicht notwendig. Hierdurch kann die Strahlenbelastung für den Patienten gering gehalten werden. Ferner kann durch die erfindungsgemäße Positionierung das Aufnehmen störender Strukturen, wie z.B. der Halswirbelsäule vermieden werden. Geringere Anforderungen an die maximale Höhe 5 des Kernvolumens 4 und entsprechend des gesamten Aufnahmevolumens ermöglichen auch die Verwendung einer kostengünstigeren Aufnahmevorrichtung bzw. geringere Herstellungskosten von Röntgenstrahler und Detektor (nicht dargestellt).In this over-extended positioning of the head 1, the core volume 4 is sufficient to detect the entire maxillary mandibular area (not shown), lower jaw 2 and temporomandibular joint 3. An increase in height 5 is not necessary. As a result, the radiation exposure for the patient can be kept low. Furthermore, the positioning according to the invention makes it possible to pick up disturbing structures, such as e.g. the cervical spine are avoided. Lower requirements for the maximum height 5 of the core volume 4 and corresponding to the total receiving volume also allow the use of a more cost-effective recording device or lower production costs of X-ray source and detector (not shown).

In Fig. 2A und 2B ist das Positionieren des Patientenkopfes 1 mittels einer Laserbereichsanzeige 12 skizziert. Für die Positionierung werden mittels eines Lasers oder einer anderen Lichtquelle (nicht dargestellt), beispielsweise mittels eines Licht- oder Laservisiers, als Laserbereichsanzeige 12 zwei Linien auf den Patientenkopf 1 projiziert, welche die Höhe 5, den Verlauf der Grundfläche 11 und die räumliche Position des Kernvolumens 4 (durch gepunktete Linien skizziert) anzeigen. Der Patientenkopf 1 wird so ausgerichtet, dass die Unterkante 10 des Unterkiefers 2 näherungsweise parallel zur unteren Linie der Laserbereichsanzeige 12 verläuft.In FIGS. 2A and 2B the positioning of the patient's head 1 is sketched by means of a laser range indicator 12. For positioning, two lines are projected on the patient's head 1 by means of a laser or another light source (not shown), for example by means of a light or laser sight, as a laser range display 12, which shows the height 5, the course of the base 11 and the spatial position of the patient Core volume 4 (outlined by dotted lines). The patient's head 1 is aligned so that the lower edge 10 of the lower jaw 2 approximately parallel to the lower line of the laser range indicator 12 extends.

Als weitere Hilfestellung für die Positionierung kann eine mittig zwischen den beiden Linien verlaufende weitere Linie projiziert werden, die bei einer optimalen Abstimmung von Position und Größe von aufzunehmendem Unterkiefer und Kernvolumen von einer Lippenspalte des Patienten zu einem Gehörgang des Patienten verlaufen sollte.As a further aid to the positioning, a further line running centrally between the two lines can be projected, which, with an optimal coordination of position and size of the lower jaw and core volume to be picked up, should extend from a cleft lip of the patient to an auditory canal of the patient.

BezugszeichenlisteLIST OF REFERENCE NUMBERS

11
Patientenkopfpatient's head
22
Unterkieferlower jaw
33
KiefergelenkTemporomandibular joint
44
Kernvolumencore volume
55
Höhe des KernvolumensHeight of the core volume
66
Halswirbelsäulecervical spine
77
Aufbissbite
88th
Okklusionsebeneocclusal plane
99
erster Winkelfirst angle
1010
Unterkante des UnterkiefersLower edge of the lower jaw
1111
Grundfläche des KernvolumensBase area of the core volume
1212
LaserbereichsanzeigeLaser Range Display

Claims (6)

  1. Method for creating a dental 3D X-ray image of a jaw region of a patient from a plurality of projection images of a recording volume having a cylindrical core volume (4) with a flat base (11) generated during a revolution of an X-ray emitter and an X-ray detector about the head (1) of a patient, wherein the patient is positioned relative to the core volume (4) such that the jaw region is located within the core volume (4) and such that the lower edge (10) of a lower jaw (2) of the patient and the base (11) of the core volume (4) are aligned at least approximately parallel, characterized in that a first angle (9) of an occlusal plane (8) or a temporomandibular joint of the positioned patient relative to the base or a lateral surface of the core volume (4) is determined and a positional correction of the 3D X-ray image by the first angle (9) is carried out.
  2. Method according to Claim 1, characterized in that a first angle (9) of an occlusal plane (8) or a temporomandibular joint of the positioned patient relative to the base or a lateral surface of the core volume (4) is determined and a positional correction of the 3D X-ray image by a second angle, which displays a fixed difference to the first angle (9), is carried out.
  3. Method according to any of Claims 1 through 2, characterized in that a mechanical positioning means is used for positioning.
  4. Method according to Claim 3, characterized in that the mechanical positioning means is a bite block (7) and/or a forehead support and/or a chin support and/or a support for the nasal root.
  5. Method according to any of Claims 1 through 4, characterized in that a light or laser range indicator (12) is used for the positioning.
  6. Method according to Claim 5, characterized in that the light or laser range indicator comprises a light or laser sight.
EP16759986.9A 2015-08-06 2016-08-05 Method for creating a 3d dental x-ray image Active EP3331448B1 (en)

Applications Claiming Priority (2)

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DE102015215048.8A DE102015215048A1 (en) 2015-08-06 2015-08-06 Method for creating a dental 3D X-ray image
PCT/EP2016/068718 WO2017021520A1 (en) 2015-08-06 2016-08-05 Method for creating a 3d dental x-ray image

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WO2018204705A1 (en) 2017-05-03 2018-11-08 Turner Innovations, Llc. Three dimensional x-ray imaging system

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DE60041069D1 (en) * 1999-10-08 2009-01-22 Gendex Corp POSITIONING DEVICE FOR THE TRANSVERSAL DENTAL X-RAY GENTOMOGRAPHY
DE19962205C2 (en) * 1999-12-22 2003-06-12 Steffen Sellerer Method and device for taking into account and correcting an original skew of the patient's head in CT
US7787586B2 (en) * 2007-02-22 2010-08-31 J. Morita Manufacturing Corporation Display method of X-ray CT image of maxillofacial area, X-ray CT apparatus and X-ray image display apparatus
DE102008035412A1 (en) 2008-07-29 2010-02-04 Sirona Dental Systems Gmbh Method for producing a dental 3D X-ray image and X-ray device therefor

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WO2017021520A1 (en) 2017-02-09
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US20180220978A1 (en) 2018-08-09
US10687769B2 (en) 2020-06-23

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